Endgame: Democrats Race Against The Clock To Pass Health Care Reform

After months of leaving the fate of his top initiative in the hands of Congress, President Obama has fully inserted himself into the health care fight on Capitol Hill. And though the final result will no doubt leave scores of Congressional Democrats bruised and resentful, his late entry into the game is beginning to pay dividends.

Yesterday, Obama and top administration officials spent eight nearly-uninterrupted hours meeting with Congressional leaders and their lieutenants to resolve the many differences between the House and Senate health care bills.

Because the political math is more complicated in the Senate, its bill will serve as the foundation for reform, and the past week has served to provide House progressives and leading union officials--hostile to the upper chamber's legislation--enough concessions to keep them from revolting. And by most accounts they've made significant progress.

Two major pressing issues remain unresolved, though: First and foremost, how will Democrats pay for providing millions of uninsured Americans with health care. Second, will insurance markets be organized at the state, or the national level.

The Senate and the White House have proposed to pay for the legislation by taxing expensive insurance plans--a policy that generates considerable savings, but draws the ire of progressives and organized labor because it would ensnare the benefits of middle class workers. Yesterday, one of the architects of the House bill, who opposes the so-called "Cadillac insurance tax," says it can be modified to lessen the impact on workers and the middle class--and that could seal the deal.

"It would be a way to lessen impact of the so-called excise tax," Rep. Robert Andrews (D-NJ) said yesterday. "I think we could build a consensus around that idea--a majority around that idea."

Separately, Democrats have to figure out whether new insurance exchanges will be organized and regulated at the federal or state level. House Democrats want insurance markets to meet strict federal standards, while the Senate leaves it up to the states. Obama has reportedly signaled in private that he prefers the House method, but according to House members and aides, the compromise language on the table isn't good enough--yet.

"I've seen language," Andrews said. But it's not where he wants it to be, and House aides agree that leadership wants to see more deference given to the House on this issues.

The marathon White House meeting will continue this morning, ahead of President Obama's visit to the Capitol to rally the caucus to pass the final bill. And the reasons for urgency couldn't be more clear. The State of the Union address is right around the corner, and a special Senate election in Massachusetts, which Democrats might lose, could throw the vote count in both chambers into disarray. (One top Senate aide said the Massachusetts election is a major reason for the Herculean push this week.)

But as Andrews notes, a call from the President can go a long way.

"There's a very mature understanding here that no one ever gets everything they want. That there are much larger questions here than any of these specifics we've talked about this afternoon," he said.

About The Author

Brian Beutler is TPM's senior congressional reporter. Since 2009, he's led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight and the debt limit fight. He can be reached at brian@talkingpointsmemo.com